Association between creatine kinase level and mortality in high-risk patients with COVID-19

Background: Multiple factors, such as male gender and diabetes mellitus(DM) are known predictors of severe coronavirus disease(COVID-19). Nevertheless, it is not always possible to predict the disease outcome in a particular patient. Elevated serum creatine kinase(CK) level in COVID-19 patients correlates with higher mortality. The objective of our trial was to evaluate association of COVID-19 outcome with CK levels in high-risk groups. Methods: 229 patients with COVID-19 without signs of myocardial damage or rhabdomyolysis were divided into groups based on gender(117 men,119 women) and presence of type 2 DM(89 with DM,140 without). CK level on admission has been compared in survived and deceased groups. Results: In men CK was significantly higher in the deceased group(345vs133 U/L, p<0.01). In patients with CK above the upper limit of normal(UPN) mortality was higher(OR=5.1, CI=1.66–15.70, p<0.01). In patients with DM, CK was significantly higher in the deceased group(309vs198 U/L, p<0.01). Mortality was higher in patients with CK level above the UPN(OR=8.53, CI=2.45–29.66, p<0.01). In men with DM, CK was significantly higher in the deceased group(396vs126.5 U/L, p<0.01). Mortality was higher in patients with CK level above the UPN(OR=7.8, CI=1.75–34.83, p<0.01). In women and normoglycemic patients there was no significant difference in CK level between survived and deceased groups. Conclusion: Results indicate clear association between CK level and mortality in men and patients with DM. Evaluation of CK level on admission in these high-risk cohorts (especially in men with DM) is valuable even in the absence of myocardial damage or rhabdomyolysis signs for more accurate assessment of the prognosis.